In Billing
Dec 14th, 2018
Follow billing guidelines to ensure proper payment for this incentive payment model. The Medicare Diabetes Prevention Program (MDPP) expanded model is a structured behavior change intervention that aims to prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of pre-diabetes. The clinical intervention consists of a minimum of 16 intensive “core” ...
Append seven modifiers appropriately to G codes for correct reporting of therapy services. In 2013, the Centers for Medicare & Medicaid Services (CMS) developed a system of functional reporting for therapy services. This system is used to report conditions and outcomes for patients receiving physical therapy (PT), occupational therapy (OT), and/or speech-language therapy (SLT). Indicate ...
In Audit
Mar 23rd, 2018
A medical review conducted by the Office of Inspector General (OIG) found 61 percent of claims (out of 300 sampled) for outpatient physical therapy services did not comply with Medicare medical necessity, coding, or documentation requirements. Although the Centers for Medicare & Medicaid Services (CMS) generally disagreed with OIG’s findings, a review of the requirements ...
In CMS
Mar 5th, 2018
Now that you’re familiar with the 2018 HCPCS Level II codes,  new C, G, K, and Q codes effective April 1 have been released by the Centers for Medicare & Medicaid Services (CMS). Several modifiers have been adjusted to reflect oxygen use. The annual quarterly updates helps CMS programs, such as the Outpatient Prospective Payment System (OPPS) ...
In Billing
Aug 26th, 2016
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires the Centers for Medicare & Medicaid Services (CMS) to develop and implement a process to gather and analyze the necessary data on pre- and post-operative visits and other services furnished during global surgical periods other than the surgical procedure itself. CMS proposes in the ...